Ferritin and Hair Loss

Ferritin and Hair Loss

Iron Physiology 101

Most of us know that low iron makes you tired. This is because you have to have iron in order to make enough hemoglobin, which is the part of your red blood cells that binds and transports oxygen. There are several forms of anemia, but one of the most common is iron deficiency anemia. Too little iron leads to too little oxygen, which leads to exhaustion.

But there are several steps in the iron pathway before red blood cell count and size begins to decline, indicative of full-blown anemia. Ferritin, which is the storage form of iron, can be an early indication of a problem.

The Connection Between Ferritin and Hair Loss

Your hair follicles actually store ferritin. When your body is short on iron for its essential functions (such as red blood cell production), it will steal it from the ferritin stored in less essential parts of the body, such as the hair follicle.

If your ferritin levels are sufficient, a single hair grows five years on average before falling out and being replaced. If ferritin is insufficient, this life cycle gets shorter. Low ferritin also affects the hair’s ability to grow, and may change the hair’s texture, rendering it weaker, more brittle, and more resistant to curl.

The Connection Between Ferritin and Thyroid

Another major cause of hair loss is hypothyroidism. Iron is also one of the key nutrients required for conversion of T4 (inactive thyroid hormone produced by the thyroid) to T3 (active thyroid), and iron deficiency increases the body’s tendency to produce more of the inactive reverse T3, rather than the active T3 hormone.

What this means is that it is possible for a patient with low ferritin to have hypothyroid symptoms (complete with hair loss) and yet appear “normal” according to the standard TSH and T4 thyroid labs.

Causes of Iron Deficiency

Decreased absorption and depletion. This can occur with proton pump inhibitors such as omeprazole, as well as prolonged ingestion of aspirin or NSAIDs. It can also occur with ingestion of too much coffee, black tea, manganese, fiber, calcium, magnesium, or phosphates (soda). This is why, if you take an iron supplement (see below), it’s important to do so on an empty stomach.

An hidden bleed. It’s always worth checking for this. Occult bleeds often show up in the GI tract, and screening may include a stool culture, colonoscopy, and/or an endoscopy.

Menstruation. Menses = iron loss, which means menstruating women are more likely to be at risk for ferritin-related hair loss. Women who bleed heavily are at even higher risk; if this is you, you’ll need to get your estrogen-to-progesterone ratio balanced as well.

SIBO. Overgrowth of gut flora in the intestines can also rob your body of iron, as certain bacteria use iron in their life cycles.

Adequate Ferritin Levels

Ferritin levels are considered normal for women between 10-120 ng/mL, and between 30-250 ng/mL for men. However, about 50-70 ng/mL are required to stop hair loss and for adequate hair regrowth.

Iron in Food

One of several reasons I don’t tend to favor vegetarian and vegan diets is because iron deficiency is so common in these patients. Although iron can be found in plant-based foods such as nuts, raisins, prunes, and whole grains, it’s difficult to eat enough of these to achieve adequate iron intake, compared to usual portion sizes and iron concentrations in meat and poultry. I simply advocate choosing free range and grass fed meat sources over agriculture-industry meats.

Should You Supplement With Iron?

Definitely not unless you’ve been tested and are definitively low. Iron is one of those nutrients for which overdose is both possible and serious if it occurs. It’s also relatively hard to absorb, so it helps if it’s given on an empty stomach, in a non-constipating chelated form, along with certain other nutrients like Vitamin C that will aid in its absorption.

It will take at least a few months and sometimes up to a year with ferritin at adequate levels before you are likely to see significant hair regrowth, so do your best to be patient.

If you have the opportunity to see a naturopathic doctor, please do so. It is always best to have someone to coordinate your care. However, if you have had your ferritin tested, if it is below 70 and if you are losing hair, I recommend this form of iron: it is gentler on the stomach and easier to absorb. Always re-check your ferritin levels in another 3 months.

Share This:

Dr. Lauren Deville is board-certified to practice medicine in the State of Arizona. She received her NMD from Southwest College of Naturopathic Medicine in Tempe, AZ, and she holds a BS in Biochemistry and Molecular Biophysics from the University of Arizona, with minors in Spanish and Creative Writing. She also writes fiction under a pen name in her spare time. Visit her author website at www.authorcagray.com.

23 Comments

This article came as a Godsend to me. I have HCT and my Ferritin recently (June) dropped to 27 via my routine phlebotomy. My hair has been falling out and the texture changed dramatically as well. I had no idea why until I realized my Ferritin had dropped much lower than usual and found your article. Typically, I keep it between 50-70. Mystery solved. I’m obviously slowing down on my production of iron and will monitor my phlebs so I don’t get my Ferritin that low again. I don’t have to go bald to manage my HCT.

i just found out i am anemic and my ferritin level is 3. my hair is falling out really bad and i am so tired. i started taking ferrous sulfate 325mg but i was wondering if there is something i can take to raise my ferritn levels fast to help with hair loss. Thank you

I’m a 29 year old healthy male who has been on a clean paleo/bulletproof diet for almost five years now. However, my last blood test came up with ferritin levels of 240ng/ml which I know is on the high end.

I don’t supplement with iron or use cast iron cookware but do take vitamin C regularly. I have long hair and have noticed small amounts coming out in the shower and when brushing. I love my hair and want to do everything I can to keep it on my head!

Are iron levels this high a concern for hair loss? I know deficiency gets more attention but I have also read iron overload can contribute as well.

Hi Nate, if you’re not taking iron and your ferritin is that high, I’d recommend asking your doctor to screen you for sources of inflammation–ferritin is what’s called an “acute-phase reactant,” meaning it can go high when the body is stressed out. Not saying there’s necessarily anything to find, but it’s worth further investigation. The high iron itself most likely won’t cause hair loss, but if it’s a sign of inflammation somewhere else, then the underlying cause might.

Wow, why did I not find this article before? I’ve been battling hair-loss for the last 3 years. My doctors don’t seem to care much. They have tested me for thyroid, hormone imbalances and such but they just call and say normal. I am going through the specific available numbers that I do have and my ferritin was 12.1 ng/mL in 2013 and 6.8 ng/mL in 2015. How in the world did they not pay attention to these levels? 6.8 is an extremely low number!! I’ll do my best to up my intake of iron strong food.

Hi Bapsy, definitely increase your iron foods, and with those levels, you probably are gonna need to supplement with it too! I’d ask your doctor to monitor your ferritin every few months as you supplement to see your progress.

I was told by my doctor that I was anemic and my iron was low. They gave me iron pills. Not only that I also was diagnosed with aloepcia. A few months I noticed I had a bald spot and when I take a shower my hair falls out a little and when I brush my hair a few hair falls out as well. Is this normal because of my iron and Aloepcia? When will my hair start falling? I am growing hair back on my bald patches.

If the cause of alopecia is JUST low iron, then your hair will stop falling out when the ferritin levels (iron stores) get above 50. So it depends on how low you were to begin with. Sometimes it can take months, so be patient! I would also ask your doctor to check your ferritin level every few months to see your progress.

It’s also possible to have multiple causes of hair loss–if that’s the case, then you’d need to get other causes (hypothyroidism, autoimmune alopecia, high androgens) assessed and addressed as well!

My hair has been falling out dramatically for over a year now. My ferritin was just tested at 63……my TSH 3.65…. I noted from your above comment that hair should stop falling once ferritin hits 50. Does this mean that my cause isn’t ferritin ?

Hi Kristen — yes, that’s correct, though above 70 is necessary for re-growth. TSH at 3.65 sounds like thyroid is the issue — most people at that level are symptomatic. (I shoot for 0.5-1.5 and ignore reference ranges, but I also check fT3 and fT4 to confirm.)

My hair has been shedding for over a year now, I was told telogen effluvium, my ferritin was 17 in November 2015 and was given an eight week course of iron but I have not been tested for my ferritin since, do you think my ferritin can still be low ??

Almost certainly you still are low. 17 is definitely low enough to account for hair loss, and it takes at least 90 days to get stores back up (the life cycle of the red blood cell). If you’re that low it might take more like 6 months. I’d definitely get it re-tested.

Thankyou….I struggle to get my doctors to do these tests, it’s so frustrating they just don’t seem to care that I’m losing my hair. I went to a trichologist who also says telogen effluvium and she gave me iron tablets and I have changed my diet to be more healthy, can you advise if I should be doing anything else ? My biggest fear is female pattern hair loss, but trichologist said definitely not, but I still fear this, I am 42 x

It depends on how long you’ve been on the iron tablets. It takes awhile to get stores back up. I know some labs will allow patients to just walk in and pay cash for tests they want done so they don’t have to have a doctor’s orders — you might google around for one of those in your area to check ferritin. If it’s still well below 50 then I’d stay the course and re-check in a few months. If it’s not coming up with iron tablets, then I’d do more extensive testing — find out if you’re not absorbing, if you have some kind of organism eating up all your iron that you need to kill, etc.

I’m glad to see renewed interest in this topic, in part, due to my initial comment on October 19, 2016 to your article written in 2014. It’s now nearly a month later and I can see improvement already, hair has stopped shedding and texture is improving. I had originally stated my Ferritin went down to 27, well, it was actually 21. Due to my HCT, the iron will build on its own and I will closely monitor it going forward. My main reason for this follow-up is tell others to be patient and they will see results. Ferritin is usually slow to rise and they may need additional help with iron supplements.

Lastly, having been diagnosed with HCT > 25 years ago, I’m sill amazed that I did not know Ferritin was stored in the hair. I thought I knew everything about this disease and its critical components. I’m happy to know how closely related it is to hair health and how I can manage it more closely to keep it in the proper range to keep my hair healthy and growing and my thyroid functioning well too. Thanks again for your important article.

My hair has been falling out drastically over the last 6 months, I have lost over 50% of my hair. I had my ferritin tested and it came back at 42. My doctor prescribed me iron polysaccharide 150mg once a day. After a month of taking these I had my ferritin tested again and it had gone down further to 38. Why would it go down when on iron supplements? Are these levels low enough to be the cause of hair loss? I have been taking them for 1.5 mo this now and have not seen any improvement at all in my hair loss. How long should I wait before considering another type of supplement?

My suspicion would be malabsorption. I would do a stool culture (to find out a) if you’re not absorbing, and b) if there’s an organism causing it), and would also send you for iron shots at this point — because yes, that is low enough to cause hair loss for sure. I’m assuming you’ve also been worked up for your thyroid and you aren’t having a ton of stress (adrenal fatigue) that might also be contributing factors.

Dr. Lauren thank you for all your information on this article. I am 22 year old male who recently past year just started noticing more and more hair fall in the shower. My hairline naturally had a little notch in it but it has gotten a lot bigger, with some thinning overall as well. No one on either side of parents is bald, I know deep down inside it isn’t just male pattern baldness, but as a human it is hard to sometimes not jump to the worst conclusions. I have been vegetarian since age 16 and admittedly haven’t eaten the greatest. Gut feeling, I think it might just be years of poor eating habits catching up to me and now as a late bloomer am finally having bodily changes that maybe require higher iron stores in my body. I got a blood test and my ferritin was 21 and my doctor started me on iron supplements at my suggestion. It has been about 4 weeks don’t really notice much but now after reading what you said I will give it a much larger timeline and try not to stress about it. Also I find it very interesting what you said about the red blood cell 90 day life cycle, I never really thought about it like that.

But I am commenting because I was wondering a couple things. One being, seems everything I’ve read on internet has to do with premenopausal women. Can I be effected by low ferritin hair loss as well? So in your opinion do you think I can possibly recover and regrow some of this lost hair from hairfall, or at least just get it to stop? Like other comments above mentioned, my doctor seemed to just brush it off. I genuinely appreciate all your feedback and taking the time to answer these comments.

Hi Michael — post-menopausal women definitely have issues with ferritin, but men can as well. It just gets less attention because male pattern baldness is a more common cause in men. I’d get your ferritin re-checked in at least another two months (three total) to make sure you’re headed in the right direction. You also might consider something like this: https://shop.drlaurendeville.com/products/hair-effects, because if your diet has been poor, there might be other nutrients at play in your hair loss. (Bonus: this product also helps to block the conversion of testosterone to dihydrotestosterone (DHT) which is implicated in male pattern hair loss.)